Megan Sandel, MD, MPH  Principal Investigator, Children’s HealthWatch  Associate Professor of Pediatrics, Boston University Schools of Medicine and Public Health  Medical Director, National Center for

Evidence on Housing Quality Accidents/Injuries – exposed wiring, needed repairs Development and worsening asthma, allergies tied - specific housing conditions Pests (cockroaches and mice) Molds/Chronic Dampness Tobacco smoke Lead exposure tied to long term effects Anemia, developmental delay, aggression, attention deficit Skinner et al, 2014

Poor housing quality strongest predictor of emotional and behavioral problems in low- income children Much of association between poor housing quality and children’s wellbeing operates through parental stress and parenting behaviors Evidence on Housing Quality

HOMELESS HIDDEN HOMELESS: HOUSING INSECURE UNAFFORDABLE HOUSING overcrowded multiple moves behind on rent Stability: The Housing Iceberg

Cutts et al, 2011 Children in housing-insecure families more likely to be Food insecure In fair/poor health At risk for developmental delays Seriously underweight (compared to children in housing-secure families)

Being behind on rent strong indicator of other household hardship Cutts et al. In preparation.

Even after controlling for food insecurity, children living in subsidized housing had healthier weights for their age, while those in food-insecure families without a subsidy were more likely to be seriously underweight.

Focus – low-income families with young children in cities with fewer subsidized units than need higher rates of housing insecurity County-level index of availability of subsidized housing –Total # sub. units available (occ + unocc) relative to demand, low-income households paying >30% of income for rent Subsidized Housing Index Bailey et al. Housing Policy Debate, 2015.

Tested changes in supply against components of housing insecurity –Behind on rent –Overcrowding –Multiple moves –Homelessness If 5% increase in supply (for every 50 additional sub housing units/1000 low-income rent-burdened HHs) approx 30% decrease each – overcrowding, multiple moves Subsidized Housing Index if supply increases what can cities expect?

Targeting the vaccine: Housing insecure, high risk pregnant/ parenting families, child <5 with complex condition requiring specialty care Secure and retain housing to –improve birth outcomes –improve the health and well-being of women and families Provision of housing Intensive case management: housing retention, engagement in services, family development plan Healthy Start in Housing Boston Public Health Commission & Boston Housing Authority

New understanding of interplay of how housing influences health Quality- Physical and mental health Stability- Beyond homelessness Affordability- Hardships are interconnected Housing can act like a vaccine Provide Multiple, Long Lasting Benefits Differential Benefits to Individuals and Society Deciding how we can pay for it requires evidence-based partnerships and creativity Housing Influences Health

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